Service Orthopaedics Women's HSM

Fractures of the upper end of femur

Trochanteric fractures of the neck of Femur Fractures
Patients Admitted in the Departments of Orthopaedics, HSM.
Sex
Male Female Total
No. of patients
535 678 1213
% Of% of patients in the patients in Services Services Orthopedics Orthopedics H
SM HSM
56% 56% 44%
Male Female
% Of inpatients second pathology
% Of patients admitted at the second age bracket Orthopaedics Women
[65-75 [;
August 1%
[45-65 [;
26%
> = 75;
37%
<1;
0%
[5-1 [, 0 [25-45 [;
0%
[1-1 [, 05 [1-5 [;
1 2%
[1-25 [; 5
5%
1, 5%
0.5%
Hip joint
Ilion
Greater trochanter of the femur head Colo Small trochanter intertrochanteric lin
e
Body of femur
• Muscles
Muscles of the hip joint
Short adductor / gracilis / pectineus
Adductor longus
Adductor magnus
Gluteus maximus
Gluteus medius
Glute minimum
Piriformis / square femoral / obturator internus
External shutter
Iliopsoas
Recto femoral
Sartorius and tensor fascia lata
Vastus lateralis
Semimembranosus
Semitendinosus
Biceps femoris long
Ligaments of the hip joint
Denervation of the hip joint
Vascularization of the hip joint
Vascularization of the hip joint
Vases Ramos round ligament capsular arteries nourishing internal
Fractures of the upper end of the femur
Intracapsular
Extracapsular
1 February 3
"The patient, usually an elderly woman, slipped and fell, no longer able to stan
d up without assistance and unable to rely on the traumatized limb ..." The pati
ent can place his feet after the fall, possibly walk a short distance ... "(impa
cted).
SERRA, 1996
Fracture femoral neck
Rare in young individuals and in patients without osteoporosis, pathologic fract
ures, risk of vascular injury affecting the movement of the proximal fragment; m
ainly affects the elderly in low-intensity trauma due to a fall.
Fracture femoral neck
Signs of fracture
In a few fragments are strongly impacted, with little abduction of the distal fr
agment on the proximal. Pain in inguinal area External rotation of the State in
which the knee and foot pointing sideways due to rotation of 90 °. Shortening 2-
3 cm; Impotence functional;
Fracture femoral neck
Fracture femoral neck
Treatment
Arthroplasty. Fixation with screws and plate
Fracture femoral neck
Most frequent complications
Avascular necrosis; Lack of consolidation; late arthrosis.
"After the fall the patient is unable to stand up alone and can not unload weigh
t on the affected member ..."
SERRA, 1996
Trochanteric fracture
Frequent in the elderly, especially in females.
Often appear between 75 and 85 years of age and the cause is almost always a fal
l.
Trochanteric fracture
Signs of fracture
Shortening and external rotation;
Pain is more intense on the trochanter;
After one or two days a bruise appears on the back of the upper thigh;
Trochanteric fracture
Trochanteric fracture
Treatment
Internal fixation with a nail plate.
Conservative
Trochanteric fracture
Most frequent complications
Few complications
Malunion;
Limb shortening rarely exceeds 2-3 cm.
but
Nursing Care and Rehabilitation
Care Nurse. preoperative general
• Psychological preparation:
• explanation of all procedures to patient; • keep the patient calm and provide
all information about your health;
• Provide information about the type of surgery and anesthesia; • Teaching about
placements allowed postoperatively as well as rehabilitation and strengthening
exercises and respiratory muscle; •
Care Nurse. preoperative general
Physical preparation: • Fasting (8 hours) before surgery; • Trichotomy lower; th
e whole member
• Remove rings, prostheses ...
# In the femoral neck Aebi, and Gloor KOCK (1997) considered important in pre-op
erative:
Education about: • placements permitted and prohibited; • Technical lateralizati
on in bed; • Early mobilization in bed; • Technical input and output of the bed;
• Transfer Mode bed-chair-toilet and bath; It is important to: • Monitoring for
signs • Review vital process of the patient
Care Nurse. Postoperative
Careful observation of nurses, due to risks of surgical procedure as well as hip
arthroplasty:
• Hematoma: • Deep vein thrombosis • Pulmonary embolism: fat embolism •: • Infec
tion: • Reaction to acrylic cement: • Dislocation of the prosthesis: • Implant p
lacement or inadequate
Care Nurse. Postoperative
• Maintenance of the vital respiratory and circulatory functions; • Muscle tonin
g; • Restoration of joint mobility; • Surveillance of the dressing and wound; •
Surveillance of drains;
Care Nurse. Postoperative
• Assessment of neurovascular extremity operated; • Cryotherapy; • Maintenance o
f fluid and electrolyte balance; • Maintenance of appropriate placements;
Care Nurse. Postoperative
• Assessment of level of consciousness. • Maintenance of an adequate blood volum
e to prevent the installation of a framework for hypotension. • Avoid sitting fo
r 70-10 days, depending on the surgeon's opinion. • The patient should keep the
legs elevated and abducted
XHARDEZ (1990) and PETITDANT and GOUILLY (1992)
Consider surgical
3
pathways
of
approach
- Anterior or antero-external - to avoid extension, abduction and external rotat
ion; - via post or Moore - avoid flexion, adduction and internal rotation - late
ral approach - avoiding adduction and external rotation. It is essential: • Asse
ssment of neurovascular end operated
Caneira (1998) finds that:
Raise the bed (5 days) taking into account: • The alternating supine to lateral
• The output of the bed • The gait training to three points should start around
the 2nd day
SERRA, 1996
• Patients with trochanteric fracture after surgery can stay in bed freely witho
ut restrictions of movement, is encouraging the active exercises of the hip and
knee from the beginning. • You can start walking with crutches in the 1st and 2n
d day after surgery and this is especially important in the elderly since they b
arely tolerate immobility.
Preparation for high
• Teachings • Prepare a letter of discharge; • Provide a leaflet; behaviors to b
e adopted are primarily determined by rules of hygiene in order to save the life
of your new joint and the prevention of movements luxantes.
PATTERN LEMOS and PROENÇA (1998):
• Avoid activities that carry hip, weights or run overwhelm
• Use Canadian (3 months) and walking to 3 points (1 month) • Avoid brisk, long
walks, standing and prolonged sitting position;
Also according PATTERN LEMOS and PROENÇA (1998):
• Do not cross your legs or flex the thigh in addition to 90; • Avoid internal a
nd external rotation; • Avoid high heels; • Use chairs sit high, device for lift
ing of the toilet seat and grab bars in shower and next to WC;
Godart (1990)
Avoid IM injections in the region nadegueira - infections.
PETITDANT and GOUILLY (1992)
•
Use assistive devices for dressing;
• Taking a bath with shower, • sexual activity is permitted; • flex the knee on
a chair so you can put your socks behind; • Use long-handled shoehorn
In the opinion of Caneira (1998)
• Sleep with a pillow abduction (8-12 months) • Sit in chairs with arms for supp
ort; • Do not bend your body over the legs from the sitting position; • The shif
ts in the bed should be made of so as to avoid twisting the trunk on the pelvis;
Aebi-MULLER, and GLOOR.MORICONI KOCK (1997) • The patient should immediately con
tact the health care team if you have any pain; • Use elastic stockings, not gai
ning weight, keep the muscle-building exercises • The patient should notify the
dentist who has a prosthetic • During the 1st month you can soak up the side are
, with a large cushion between your knees. After 3 months you can lie on the ope
rated side;
PETITDANT and GOUILLY (1992).
• The driving can be started at 3 months.
Aebi, Gloor E KOCK (1997)
• The patient between the two to three months is just a passenger;
To enter the car sits and a movement block rotates the legs inward. To exit does
the opposite;
PETITDANT and GOUILLY (1992) and AEBIMULLER, and GLOOR.MORICONI KOCK (1997)
Are the consensus that: • Swimming, gymnastics and walking selective avoiding un
even ground are indicated • The tennis and riding are contraindicated. • The pat
ient should be taught about the correct way up and down stairs Climbing, 1st pla
ce on the rung above the foot are and then the Canadian and foot patient; When d
escending, 1st place on the step below the Canadian, followed by if the foot and
then the patient is standing.
In relation to trochanteric fracture:
Since consolidation is faster, the period of hospitalization in general less; Pr
eparation for the high does not include many teachings and for the hip prosthesi
s:
-
strengthening exercises for muscle toning.
and
Education should also focus on prevention of falls:
• use rubber shoes, with soles
• Finding strategies to eliminate architectural barriers; • using artificial eye
s, hearing or
• use of gait aids; • perform moderate exercise; • use of hip protectors;
All this because:
The most deadly injury to a human limb can suffer at any age is the fracture of
the upper extremity of the femur, particularly the neck, whose mortality and mor
bidity increases with age and its associated diseases, making it the most common
cause of traumatic death after 75 years "
R. Tronzo, 1973
Thank you for your attention ...
Work done by: Fábio Gonçalves